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Abstract This study investigated glymphatic system integrity in prodromal Parkinson’s disease (pPD) using diffusion tensor imaging analysis along the perivascular space (DTI-ALPS) technique, analyzing data from 51 healthy controls, 83 pPD individuals, and 202 de novo Parkinson’s disease (dnPD) patients. The DTI-ALPS index was significantly reduced in both pPD and dnPD groups compared to controls and correlated with anxiety scores and cerebrospinal fluid tau levels in the pPD group. Longitudinal analysis revealed that a higher DTI-ALPS index was associated with a lower risk of conversion from pPD to clinical PD, suggesting that glymphatic dysfunction in pPD may serve as a predictive biomarker for disease progression.
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